Thymic Cancer

The day a person learns they have thymic cancer is often the same day they learn about the thymus gland. This little-known organ located under the breastbone is vital to developing and maintaining our immune system. From infancy to adulthood, the thymus does its job and then shrinks. In rare cases, the thymus becomes cancerous. When it does, they are called thymic epithelial tumors (or TETs), which consist of thymoma and thymic carcinomas.

Fewer than 1,000 patients are diagnosed with thymus cancers annually in the United States.

Physicians and researchers at the Indiana University Melvin and Bren Simon Comprehensive Cancer Center are building on decades of expertise to expand our understanding of TETs. IU research is taking on thymoma from every angle – from understanding thymoma at the molecular level and using artificial intelligence to propel research forward to developing new clinical studies and exploring immunotherapy.

With unparalleled expertise in this rare disease, IU is considered a leader in thymoma research. Our donors are critical partners in our continued progress. Your gifts serve as vital funding for our talented researchers to pursue bold ideas. You enable them to gather data, launch clinical trials, and continue to improve outcomes for thymoma patients.

Since the early 1980s, our investigators have led basic research and clinical studies, making IU an international leader for thymoma.

Clinical trials led by Patrick J. Loehrer Sr., MD, and other IU experts have informed the international standards for frontline treatments of thymic tumors. Dr. Loehrer has devoted his career to studying thymus cancer and improving treatments for patients. Those early clinical trials led to what remains one of the standards of therapy today. Many of the National Comprehensive Cancer Network guidelines for first-line and second-line therapies are a result of IU-led clinical trials or cooperative trials.

Over the last 40 years, Dr. Loehrer and the IU surgical team – including DuyKhanh ‘Mimi’ Ceppa, MD, Thomas Birdas, MD, Karen Rieger, MD, and Chad Denlinger, MD – have treated more thymus cancer patients than any other team in the country. Because so many patients turn to IU for treatment, the cancer center has one of the world's largest collections of thymus tumor specimens. More than 750 patients have provided serum and/or thymic tumor tissue samples that IU investigators can access for basic and translational research.

IU researchers led the effort to characterize the molecular structure and function of thymomas and thymic carcinomas for The Cancer Genome Atlas at the National Cancer Institute.

This project, directed by Dr. Loehrer, involved 149 scientists from 24 institutions and 6 countries. In addition to leading the effort, IU was among the most significant contributors to the study, providing 20 percent of the tumor and patient health data analyzed.

This seminal paper continues to drive new research at IU and beyond as investigators build on those findings and explore the genomic interrogation of thymic tumors.

The GIFTT of patient models

Patients who contribute their tissue and blood samples for biobanking are making a meaningful gift to research since it is such a rare disease. Another way patients are contributing to research is through the Genomic (and Immunologic) Interrogation of Thymic Tumors, or the GIFTT program, led by Dr. Maniar.

Using tumor tissue removed during surgery, researchers can develop models called patient-derived xenografts (PDX) and cell-derived xenografts (CDX) models. These meticulously developed models can take as long as a year or more to develop since thymic tumors are often slower to grow. The goal is to use these models for drug screening to understand which therapies would work best for these unique thymic tumors. Karen Pollok, PhD, assists in this project.

More than 15 patients have already given their tumor tissue to the GIFTT program, and investigators have started the process of drug screening on the first models. Additionally, researchers envision these models helping the patients who donated – if that patient relapses, they could use what they learn from the model to personalize future treatments.

With vast amounts of data available to decipher, IU researchers are at the forefront using artificial intelligence, or AI, to drive discoveries in thymoma. IU researchers are using AI to conduct one of the largest-scale analyses of thymic tumors to create models to predict which patients will benefit from which treatment.

Dr. Maniar and Dr. Loehrer are collaborating with cancer center investigator Spyridon Bakas, PhD, an internationally recognized computational researcher. By analyzing radiomics (data from medical images) and pathologic data, these models could help guide treatment plans – such as if a patient may benefit from chemotherapy before surgery or which treatment would be best for metastatic disease.

Unlike other cancers, thymic tumor research has not yet identified predictive biomarkers for targeted treatments. This AI research could help identify predictive biomarkers for thymic tumors so researchers can determine who benefits from specific drugs and who may be at higher risk for harmful side effects of chemotherapy.